Nephrology Dialysis Transplantation, Vol 13, Issue 5 1206-1210, Copyright © 1998 by Oxford University Press
S Albitar, R Genin, M Fen-Chong, M Serveaux and B Bourgeon
Background: The resistence to recombinant human
erythropoietin (rHuEpo) therapy in haemodialysis (HD) patients has
multifactorial aetiologies; erythropoietin insufficiency, dialysis
insufficiency, iron deficiency, and secondary hyperparathyroidism.
Angiotensin-converting enzyme (ACE) inhibitors induce anaemia in patients
with essential hypertension, congestive heart failure, chronic renal
insufficiency, and renal transplants. Data exist suggesting that ACE
inhibitors impair erythropoiesis in HD patients. Therefore the aim of this
study was to investigate the impact of enalapril on rHuEpo requirement.
Methods: In the present prospective non-randomized
study of 12 months, we compared the effects of enalapril and nifedipine on
rHuEpo requirement in 40 hypertensive patients receiving rHuEpo for more
than 6 months on maintenance haemodialysis. Twenty normotensive
rHuEpo-dependent patients served as a control group. All patients with
severe hyperparathyroidism or iron deficiency were excluded. The mean
(±SD) haemoglobin concentration was >10 g/dl in all
groups. The mean weekly rHuEpo dose increased in the enalapril group
(P<0.0001 vs before) and remained constant in
the nifedipine and control groups (P=NS vs before).
Statistically, there was no differences with regard to iPTH levels,
dialysis parameters, iron status, and underlying renal diseases among all
groups. Conclusion: High-dose enalapril increases
rHuEpo requirement and should be reserved for dialysis patients with
hypertension uncontrollable with other antihypertensive medications or
dialysis patients with cardiac failure. Key words:
anaemia; enalapril; erythropoietin requirement; haemodialysis
ORIGINAL ARTICLES
High dose enalapril impairs the response to erythropoietin treatment in haemodialysis patients
Department of Nephrology, Felix Guyon Hospital and AURAR, St Denis, France; Corresponding author at: Haemodialysis Centre, AURAR, 6 Av Stanislas Gimart, F-97490 Ste Clotilde, France
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